Provider Demographics
NPI:1396725552
Name:NITI VAID, DO, FACP
Entity type:Organization
Organization Name:NITI VAID, DO, FACP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NITI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-305-4690
Mailing Address - Street 1:4607 LAKEVIEW CANYON RD # 159
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4028
Mailing Address - Country:US
Mailing Address - Phone:818-305-4690
Mailing Address - Fax:262-394-0871
Practice Address - Street 1:32144 AGOURA RD STE 118
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4046
Practice Address - Country:US
Practice Address - Phone:818-707-0290
Practice Address - Fax:818-707-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-21
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI52507Medicare UPIN